| NPI | 1700959194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 2532) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204223) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2013-11-20 |